Download - Tumors of the hypopharynx
![Page 1: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/1.jpg)
Tumors of the hypopharynx
ByLt Col Saeed Ullah, MBBS, FCPS
Classified ENT, Head and Neck Surgeon
![Page 2: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/2.jpg)
Anatomy
![Page 3: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/3.jpg)
Anatomy
• Pyriform sinus
• Post cricoid region
• Posterior pharyngeal wall
![Page 4: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/4.jpg)
![Page 5: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/5.jpg)
Aetiology
• Smoking tobacco.• Chewing tobacco.• Heavy alcohol use.• Eating a diet without enough nutrients.• Having Plummer-Vinson syndrome.• There is a significant association with alcohol
and smoking, acting synergistically
![Page 6: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/6.jpg)
Aetiology
• Role of genetic factors- association between tobacco use and p53 mutations is found in a much larger percentage of smokers and drinkers
• The loss of heterozygosity at 9p and abnormalities in chromosome 11 present.
• Mutations in the p21 gene have also been identified.
![Page 7: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/7.jpg)
Aetiology
• The role of human papilloma virus (HPV) as a contributing factor to carcinogenesis in head and neck squamous cell carcinomas.
• Occupational exposures mainly asbestos and welding fumes.
![Page 8: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/8.jpg)
Benign tumors
a) Papillomab) Adenomac) Lipomad) Fibromae) leiomyoma
![Page 9: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/9.jpg)
Malignant tumors
Most of the tumours are squamous cell type with various grades of differentiation
a) Pyriform sinus (60%)b) Post cricoid region (30%)c) Posterior pharyngeal wall (10%)
![Page 10: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/10.jpg)
Carcinoma pyriform sinus
• Mostly affects male above 40 years of age• Growth is either Exophytic, ulcerative and
deeply infiltrative• Because of large size of pyriform sinus growth
of this region remain asymptomatic for long time
• Metastatic neck nodes is the most common presenting symptom
![Page 11: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/11.jpg)
![Page 12: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/12.jpg)
![Page 13: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/13.jpg)
Spread
• Upwards: vallecula and base of tongue• Downwards: post cricoid region• Medially: AE fold and ventricle• Laterally: thyroid cartilage, thyroid gland and may
present as soft tissue mass in neckLymphatic spread: upper and middle group of
jugular cervical nodesDistant metastasis: occur late and may be seen in
lung, liver, bone
![Page 14: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/14.jpg)
![Page 15: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/15.jpg)
Clinical features
• Metastatic neck nodes may be the first sign• Sticking/pricking sensation in throat• Referred otalgia• Odynophagia• Dysphagia• Hoarseness of voice• Stridor
![Page 16: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/16.jpg)
Diagnosis
• Indirect laryngoscopy• Barium swallow• Flexible nasopharyngoscopy• CT scan: helpful to evaluate the extent of
growth and status of nodes• Direct laryngoscopy and biopsy
![Page 17: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/17.jpg)
Barium swallow
![Page 18: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/18.jpg)
CT scan
![Page 19: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/19.jpg)
Endoscopy
![Page 20: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/20.jpg)
Treatment
• Early growth without nodes– radiotherapy (preserves voice)
• Growth limited to pyriform fossa– total laryngectomy and partial
pharyngectomy and pharyngeal reconstruction often combined with neck dissection
![Page 21: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/21.jpg)
Treatment
• Growth extending to post cricoid region– total laryngopharyngectomy with neck
dissection. Pharyngo-oesophageal segment is reconstructed with myocutaneous flap or gastric pull up
• Post operative radiotherapy
![Page 22: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/22.jpg)
Carcinoma post cricoid region
• Constitutes 30% of hypopharyngeal tumours
• Plummer-Vinson syndrome is an important etiological factor (seen in 1/3rd of patients)
![Page 23: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/23.jpg)
Clinical features
• Females are usually affected in the age group of 20-40
• Progressive dysphagia (predominant presenting symptom)
• Voice change• Weight loss
![Page 24: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/24.jpg)
• Spread: local spread to cervical oesophagus, arytenoids, RLN and cricoarytenoid joint
• Lymphatic spread to paratracheal nodes, may be bilateral due to midline nature of lesion
![Page 25: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/25.jpg)
Diagnosis
• laryngeal crepitus will be lost• Indirect laryngoscopy• lateral soft tissue neck x-ray• Barium swallow• CT scan• Direct laryngoscopy and biopsy
![Page 26: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/26.jpg)
Treatment
• Prognosis is poor with irradiation and surgical treatment
• Radiotherapy: preserves laryngeal function• Surgical: laryngo-pharyngo-oesophagectomy
with gastric pull up or colon transposition for reconstruction
![Page 27: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/27.jpg)
Carcinoma post pharyngeal wall• Least common hypopharyngeal malignancy• Mostly seen in males above 50 years of age
![Page 28: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/28.jpg)
Clinical features
• Dysphagia• Metastatic neck node
![Page 29: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/29.jpg)
• Spread: prevertebral fascia, muscles and vertebrae
• Lymphatic: usually bilateral, retropharyngeal and deep cervical nodes involved
![Page 30: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/30.jpg)
Diagnosis
• Indirect laryngoscopy• lateral soft tissue neck x-ray• CT scan• Direct laryngoscopy and biopsy
![Page 31: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/31.jpg)
Treatment • Early lesions radiotherapy early small lesions surgery by lateral
pharyngotomy approach advanced lesions
laryngopharyngectomy with block dissection
![Page 32: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/32.jpg)
![Page 33: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/33.jpg)
Questions
![Page 34: Tumors of the hypopharynx](https://reader036.vdocument.in/reader036/viewer/2022062316/587e43a41a28ab9f5d8b7db3/html5/thumbnails/34.jpg)
Thank you